Facial rehabilitation of severe electric burn injury to face using tissue expansion

4-year-old Choreen Vidoet from Seychelles was a bubbly toddler when one day she met with an unfortunate mishap. Accidentally she suffered a severe electric burn injury to the left side of her mouth, nose and face. After immediate first aid treatment in Seychelles, she was referred to craniofacial surgeon Dr. S.M. Balaji for specialized facial reconstruction.

Electrical burns to the mouth due to household appliances are frequently seen in children. The saliva which is rich in electrolytes acts as a good conductor of electricity. It allows arcing and concentration of the burn.

  • The child suffered severe burns of the left side of her face; the child after reconstructive surgery

    The child suffered severe burns of the left side of her face; the child after reconstructive surgery

  • Forehead fracture being treated

    Tissue expander device used to stretch healthy skin and grow tissue locally

  • Upper jaw with empty sockets

    Tissue expander device being infused with saline

  • Inflating the device stretches the skin and new tissue is grown

    Inflating the device stretches the skin and new tissue is grown

  • Lower jaw without teeth

    The newly grown excess tissue is mobilized to reconstruc the burnt portions of the face

  • Teeth inserted in the lower jaw sockets

    Nose reconstructed using forehead flap

Choreen had severely burnt mouth, nose and left cheek causing a facial disfigurement in the left half of her face. It is important that the child eats and drinks as normal. Effective management is essential to prevent loss of function & cosmetic disfigurement and reduce the psychological trauma that can be associated with any severe burn. Reflecting the potential gravity of facial injury, Dr. Balaji devised an advanced surgical treatment plan. Wound debridement was done. Dead skin and tissue were removed.

Conventionally, skin grafts and transplants are often used to produce cosmetic result. This is usually obtained from inner thighs of the patient that will result in scar formation. Moreover the graft will be of different color shade, texture and thickness. Considering the young age of this girl child, Dr. Balaji used the latest innovation called “Tissue expanders”.

Tissue expansion is a surgical procedure to grow extra skin through controlled mechanical overstretches. It creates skin locally that matches the color, texture and thickness of the surrounding tissue, while minimizing scars and avoiding secondary surgery for graft in sensitive inner thigh.

For Choreen, an inflatable balloon-like device called tissue expander was implanted beneath normal healthy skin of the cheek. Over the next few weeks, 15 ml of saline was injected into the expander per week. This inflated the balloon exerting a constant mechanical pressure and stretching the overlying healthy skin and tissue. Cell growth led to formation of new cells. After due interval, the tissue expander was removed. The excess skin grown locally was used to successfully reconstruct the burn wounds of the mouth and cheek.

The child’s nose was reconstructed with a surgical flap from the forehead. A graft with section of the skin and blood vessels was taken from the forehead, rotated and the nose was reconstructed with the base of the graft still attached to the forehead. After a few days, blood supply was established and the graft was cut off from the forehead. With this reconstruction, there is no color mismatch and it improves the appearance of the nose.

Baby Choreen has a virtually a new face reconstructed and sculpted by Dr. S. M. Balaji. Tissue expansion technique has been used for the first time for an extensive facial reconstruction in an Indian craniofacial unit. Since the skin used was from the child’s cheek, there was no color mismatch and the wound healed well while completely avoiding an additional skin grafting surgery and scarring on the child’s thigh. The parents were happy to see their child defect free and thanked Dr. Balaji.